In certain instances of accident or illness, it is necessary to perform intubation of the trachea in order to allow continued breathing by a patient. Such a process was first described in the late 1800""s. The trachea was intubated via the mouth utilizing a short metal tube for purposes of resuscitation and positive pressure ventilation. Since that time the endotracheal tube has evolved to a disposable flexible plastic tube of varying diameters and lengths used in newborns, children and adults.
In the case of the larger endotracheal tubes, a low pressure, high volume, thinwalled, rubberized cuff is inflated with air using a small separate line and valve system. This allows the cuff to create a seal between the endotracheal tube at its distal portion and the trachea of the patient. The proximal portion of the tube projecting from the mouth or nose of the patient allows connection to standard ventilating devices.
Endotracheal tubes also are temporarily used for inhaling general anesthesia or establishment of an artificial airway or for purposes of ventilatory support. In some instances, the endotracheal tube may remain in place for up to two or three weeks or longer. Complications arising from endotracheal intubation of the trachea are development of tracheitis, bronchitis, or pneumonia. What is known to the medical profession, is that various types of illnesses related to the trachea tube, and the fluid accumulations that may occur, frequently lead to illnesses, and their complications, which can have serious results. Studies have revealed secretions around the endotracheal tube cuff tend to pool in the space above the cuff as well as in the posterior oropharynx. These secretions arise from the mouth, nose, sinuses, gastroesophageal secretions and products of enteral feeding.
Furthermore, gastric reflux and accumulation of oral/nasal secretions during surgery can result in aspiration while the patient is intubated during surgery, particularly in high risk operative procedures. High risk patients are those who undergo emergency surgery, like in trauma or obstetric cases, long operations (four hours or more), upperD.N. abdominal surgeries requiring manipulation of the stomach or patients with known hiatal hernia or severe gastroesophageal reflux disease. The precise incidence is unknown since it often occurs in an occult fashion and only is implicated retrospectively when the postoperative patient develops pneumonia or respiratory failure six to twenty-four hours after surgery.
A safe, effective and reliable means for evacuating these secretions from above the endotracheal tube cuff would most generally reduce the severity and/or frequency of ventilator associated pneumonia and other diseases.
It is one object of the invention to provide an apparatus and method for the safe, effective and reliable means for evacuating these secretions from above the endotracheal tube cuff.
Another object of the invention is to provide such an apparatus that can be introduced into the patient adjacent a prepositioned endotracheal tube.
Another object of the invention is to provide such an apparatus that can be introduced into the patient adjacent a prepositioned endotracheal tube by using preattached clips that can slidingly engage the prepositioned endotracheal tube.
Still another object of the invention is to provide such an apparatus that can be introduced into the patient attached to and along side the endotracheal tube.
The present invention provides a sump assembly which allows removal of the secretions around and near the endotracheal tube cuff, while the endotracheal tube remains in the nasal or throat passages of the patient. Such secretions are typically located in the pharynx, supraglottic region, infraglottic region, and trachea region. The endotracheal tube sump of the present invention reduces the pooling of secretions by removal thereof, thus preventing pneumonia, bronchitis and other related diseases. The sump fits partially around the tracheal tube and when being installed or removed follows the path of the endotracheal tube down to the endotracheal tube cuff.
The endotracheal tube sump includes a tubular body with a distal end and a proximal end. The distal end includes a drain which can be formed as part of the tubular body or formed of flexible, or perhaps even semi-rigid, e.g. formed of a polymer, or other appropriate material, and even in certain instances rubber containing silicone. This drain contains at least one port, or perhaps several ports, through which secretions enter into the tubular body to be removed through the proximal end by a suction means. Located at or near the distal end is a guide affiliated with the drain. Another guide, ring or partial annulus, identified as a proximal guide can be positioned at the proximal end of the tubular body. Depending on the length of the tubular body, one or more proximal guide may be provided. The guide is comprised of an open ring of flexible material and is sized to easily fit around the endotracheal tube. Hence the sump is slidably inserted into the patient, and follows the path of the endotracheal tube.
Beyond the last proximal guide, is attached a connecting fitting to a suction catheter. The fitting provides attachment of the sump assembly to an external suction means or vacuum source or other appropriate attachment, including syringe fittings, stop cocks and other devices intended to irrigate or provide installation of other materials.